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Placing a family member or loved one in a nursing home or assisted living facility is a very difficult decision.  Nursing home residents typically require assistance with many activities of daily living and require careful monitoring and attention by the facility's staff.  These vulnerable nursing home residents are at risk for serious injury if they do not receive proper and adequate care.  For instance, nursing home residents may suffer serious life-threatening injuries resulting from falls, bedsores, medication errors or failures to monitor the resident.       

Most physicians would agree that the minimal standards of care applicable to such nursing homes facilities is:
(1) to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable;
(2) to prevent the resident from experiencing falls, including but not limited to the development and implementation of fall prevention mechanisms;
(3) to develop, document, implement and monitor the efficacy of a comprehensive care plan to achieve the highest practical physical, mental and psychosocial well-being consistent with the resident's condition and advance directives and revise the care plan as needed;
(4) to perform a comprehensive assessment of the resident's physical, mental, and psychosocial needs on initial admission and any subsequent admissions;
(5) to maintain an accurate and complete clinical record that reflects (a) the care and treatment provided to the resident; (b) the resident's current condition and any changes in the clinical condition; (c) any responses to interventions; and (d) a record of communication between the physician and the facility staff regarding the resident's condition and care and treatment plan;
(6) to promptly and thoroughly assess all changes in the resident's physical, mental and psychosocial condition, and communicate such changes to the attending physician;
(7) to implement any care and treatment ordered by the attending physician;
(8) to ensure that all significant, non-emergent changes in the resident's physical, mental and psychosocial condition are promptly communicated to the physician;
(9) to maintain an accurate and complete clinical record that reflects (a) the care and treatment provided to the resident; (b) the resident's current condition and any changes in the clinical condition; (c) any responses to interventions; and (d) a record of communication between the physician and the facility staff regarding the resident's condition and care and treatment plan;
(10) to follow up and report diagnostic study reports to the attending physician in a timely manner.


Patients residing at nursing homes are often at risk of developing pressure sores/decubitus ulcers as a result of their underlying health problems and immobility issues.  A pressure sore/decubitis ulcer is a bedsore that comes from lying in the same position too long and is associated with pain. 

Nursing home patients experience pressure from the bed and/or chair to certain points on their skin preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection.

Pressure is a primary contributing factor to the development of pressure ulcers.  Since the development of pressure ulcers depends on the length of time pressure is applied, immobility is the major risk factor.  Pressure must be relieved.  Malnutrition and adequate hydration have been linked to the development of pressure ulcers. 

A stage one ulcer presents as redness of the skin and represents tissue injury and heralds skin ulceration.  A stage one ulcer is classified as nonblanchable erythema with intact skin.  Erythema is redness of the skin produced by congestion of the capillaries.  Erythema is the initial reactive hyperemia caused by pressure, and nonblanchable erythemia represents s stage one pressure ulcer.

A stage two ulcer is characterized by partial-thickness skin loss, that is, the epidermis is interrupted as an abrasion, blister or shallow crater.

A stage three ulcer features full-thickness skin loss involving damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a crater, with or without undermining of adjacent tissue.

A stage four ulcer involves full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

With stage 3 or 4 pressure ulcers, the extent of the disease may not be evident because of covering necrotic material or eschar.  To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required.  When ulcers develop over bony prominences, osteomyelitis is a potential complication.  Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can be painful and life threatening.

Ultimately, pressure ulcers are avoidable so long as proper care and preventative measures are instituted and implemented by the nursing home.  In fact, under new Medicare guidelines, hospitals are no longer reimbursed for additional care resulting from bed sores and several other "reasonably preventable" errors including objects left in the body after surgery. The government has determined that development of bedsores at a hospital is a so-called "never event."

Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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Nursing home residents may be at risk of developing bedsores (also known as pressure ulcers or decubitus ulcers) as a result of their underlying health problems and immobility issues.  A pressure sore/decubitis ulcer is a bedsore that comes from lying or sitting in the same position too long and is associated with pain.  These pressure sores are generally avoidable so long as the nursing home staff: (1) provides proper preventative care (including turning, or repositioning, residents); and (2) develops, implements and (when necessary) updates a comprehensive care plan to prevent pressure ulcers from occurring and to prevent pressure sores from deteriorating. 

In order to comply with the minimum standards of care, nursing homes must: (1) ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were unavoidable; and (2) ensure that a resident having pressure ulcers receives necessary treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  This includes turning and repositioning the resident at least every two hours while in bed.

Nursing home residents are often placed in chairs (including wheelchairs or Geri-chairs) for long time periods and even allowed to nap in these chairs for hours at a time.  Sitting residents experience more pressure to their buttocks area than they would experience if lying down, preventing the blood from flowing into those points.  Pressure must be relieved by turning or repositioning such residents more frequently than residents lying in bed.

The federal government has developed clinical practice guidelines requiring residents who are sitting to be repositioned at least every hour.  According to Clinical Practice Guideline Number 15 for Treatment of Pressure Ulcers published by the United States Department of Health and Human Services in December of 1994:

While Sitting.  Interface pressure may be particularly high over sitting surfaces.  When a pressure ulcer has formed on such a surface, the individual should avoid sitting.  If pressure on the ulcer can be totally relieved, the person can sit for a limited time.  Proper postural alignment, distribution of weight, balance, stability, and continuous pressure relief are important positioning considerations for the sitting individual.  A written plan for the use of positioning devices should be developed and implemented.  An individually prescribed seat cushion should be used and donut-type devices should be avoided.  Sitting individuals should be repositioned at least every hour and should shift their weight every 15 minutes if possible.  If hourly repositioning is not feasible, the individual should be returned to bed.

(Emphasis added).

Unfortunately, in our cases, we have encountered situations where nursing home residents were allowed to sit for hours at a time without being repositioned and pressure sores developed.  Once a bedsore/pressure ulcer/decubitis ulcer develops, it can be difficult to reverse, become infected and quickly progress to a stage 3 or stage 4 decubitus ulcer.  A stage three ulcer involves full-thickness skin loss and damage or necrosis of subcutaneous tissue that may extend to, but not through, the underlying fascia.  The ulcer appears as a crater, with or without undermining of adjacent tissue.  A stage four ulcer involves full-thickness skin loss with extensive destruction, tissue necrosis, or damage to muscle, bone, or supporting structures (e.g., a tendon or a joint capsule).

With stage 3 or 4 pressure ulcers, the extent of the disease may not be evident because of covering necrotic material.  To establish the extent of the disease and promote healing, the necrotic material needs to be removed and surgical consultation may be required.  When ulcers develop over bony prominences, osteomyelitis is a potential complication.  Pressure ulcers are chronically contaminated wounds and the combination of bacteremia and pressure sores can result in sepsis and death.   

Please feel free to contact the lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury as a result of bedsores/pressure sores/decubitus ulcers or elderly abuse or neglect

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Maryland COMAR Regulation 10.07.02.12 sets forth the responsibilities of the Director of Nursing in Maryland nursing homes.  Pursuant to Maryland COMAR Regulation 10.07.02.12G, the Director of Nursing is responsible for, among other duties, "planning for the total nursing needs of patients to be met" and "execution of patient care policies."  This section may ultimately support a cause of action against the Director of Nursing in a nursing home negligence case involving bedsores (also known as decubitus ulcers or pressure ulcers). 

Under Maryland's nursing home regulations, nursing homes are required to file a signed copy of the agreement between the Nursing Home Administrator and the Director of Nursing that, among other things, specifies the duties of the Director of Nursing.  This information can be obtained from the State via public information request and we routinely obtain this information in our cases.

Most qualified medical experts would agree that the standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable.  The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.

Unfortunately, once a bedsore has progressed to stage 3 and stage 4, it can be difficult to achieve healing and avoid painful and life-threatening complications such as osteomyelitis (infection of the bone) and sepsis (blood infection). 

Please feel free to contact the nursing home neglect lawyers at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

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Your Name: Email Address: Phone Number:

According to Taber's Medical Dictionary, sepsis is defined as "the spread of an infection from its initial site to the bloodstream, initiating a systemic response that adversely affects blood flow to vital organs."  This condition can prove fatal and is a common cause of death in the elderly population including nursing home residents.

Sepsis can result from numerous conditions including bedsores (also known as pressure ulcers or decubitus ulcers).  A pressure ulcer is a bed sore caused by unrelieved pressure on the skin that comes from lying in the same position too long and is associated with pain.    Nursing home patients experience pressure from their bed and/or chair to certain points on their skin preventing the blood from flowing into those points.  Because the blood is not allowed to flow into those points, the skin, deprived of nutrients and oxygen, can become injured and susceptible to infection. 

Nursing home residents may be at risk for bedsores as a result of their underlying health problems and/or immobility issues.  The United States Centers for Disease Control and Prevention ("CDC") published a paper in February of 2009 entitled "Pressure Ulcers Among Nursing Home Residents: United States, 2004" concluding that "pressure ulcers are serious and common medical conditions in U.S. nursing homes, and remain an important public health problem." 

The standard of care applicable to nursing homes requires the nursing home staff to ensure that a resident entering the facility without pressure ulcers does not develop them unless the resident's clinical condition demonstrates that they were medically unavoidable.  The nursing home staff must also ensure that a resident having pressure ulcers receives necessary and proper wound care treatment and services to promote healing, prevent infection and prevent new ulcers from developing.  The nursing home staff must relieve pressure by turning and repositioning the resident at least every two hours while in bed and every hour while in a Geri-chair or wheelchair, maintain adequate nutrition and hydration, and prevent contractures of the extremities.

Unfortunately, once a bed sore has progressed to stage 3 and stage 4, it is difficult to achieve healing and avoid painful and life-threatening complications.  These patients may develop osteomyelitis (infection of the bone) and sepsis (blood infection) ultimately resulting in death. 

Oftentimes, the death certificate will list sepsis as the primary cause of death and include osteomyelitis and/or decubitus ulcers as contributing death factors.  In these circumstances, it may be advisable to consult with an attorney if you have reason to believe that the bedsores developed at the nursing home and were not timely diagnosed and/or treated.

Please feel free to contact the nursing home neglect attorneys at Dever & Feldstein, LLC at (888) 825-9119 for a free consultation if you believe that a family member or loved one has sustained serious injury or wrongful death as a result of bed sores (also known as pressure sores or decubitus ulcers), nursing home falls, dehydration/malnutrition, medication error/prescription mistake, elder abuse or elder neglect.

Contact Our Firm
Your Name: Email Address: Phone Number:

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